Organization
ANGEL OF GOD HEART SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL NICKERSON (OWNER)
(863) 440-2824
Entity
Organization
Contact information
Practice address
1662 TANGELO ST, LAKE WALES, FL 33898-7406
(863) 440-2824
Mailing address
1662 TANGELO ST, LAKE WALES, FL 33898-7406
(863) 440-2824
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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